Improvement in thyroid ultrasound report quality with radiologists' adherence to 2015 ATA or 2017 TIRADS: a population study.

Objectives: There has been slow adoption of thyroid ultrasound guidelines with adherence rates as low as 30% and no population-based studies investigating adherence to guideline-based malignancy risk assessment. We therefore evaluated the impact of adherence to the 2015 ATA guidelines or 2017 ACR-TIRADS guidelines on the quality of thyroid ultrasound reports in our healthcare region. Methods: We reviewed 899 thyroid ultrasound reports of patients who received fine-needle aspiration biopsy and were diagnosed with Bethesda III or IV nodules or thyroid cancer. Ultrasounds were reported by radiology group 1, group 2, or other groups, and were divided into pre-2018 (before guideline adherence) or 2018 onwards. Reports were given a utility score (0-6) based on how many relevant nodule characteristics were included. Results: Group 1 had a pre-2018 utility score of 3.62 and 39.4% classification reporting rate, improving to 5.77 and 97.0% among 2018-onwards reports. Group 2 had a pre-2018 score of 2.8 and reporting rate of 11.5%, improving to 5.58 and 93.3%. Other radiology groups had a pre-2018 score of 2.49 and reporting rate of 32.2%, improving to 3.28 and 61.8%. Groups 1 and 2 had significantly higher utility scores and reporting rates in their 2018-onward reports when compared to other groups' 2018-onward reports, pre-2018 group 1 reports, and pre-2018 group 2 reports. Conclusions: Dedicated adherence to published thyroid ultrasound reporting guidelines can lead to improvements in report quality. This will reduce diagnostic ambiguity and improve clinician's decision-making, leading to overall reductions in unnecessary FNA biopsy and diagnostic surgery.

Tamm plasmons in metal/nanoporous GaN distributed Bragg reflector cavities for active and passive optoelectronics.

We theoretically and experimentally investigate Tamm plasmon (TP) modes in a metal/semiconductor distributed Bragg reflector (DBR) interface. A thin Ag (silver) layer with a thickness (55 nm from simulation) that is optimized to guarantee a low reflectivity at the resonance was deposited on nanoporous GaN DBRs fabricated using electrochemical (EC) etching on freestanding semipolar (2021¯) GaN substrates. The reflectivity spectra of the DBRs are compared before and after the Ag deposition and with that of a blanket Ag layer deposited on GaN. The experimental results indicate the presence of a TP mode at ∼ 454 nm on the structure after the Ag deposition, which is also supported by theoretical calculations using a transfer-matrix algorithm. The results from mode dispersion with energy-momentum reflectance spectroscopy measurements also support the presence of a TP mode at the metal-nanoporous GaN DBR interface. An active medium can also be accommodated within the mode for optoelectronics and photonics. Moreover, the simulation results predict a sensitivity of the TP mode wavelength to the ambient (∼ 4-7 nm shift when changing the ambient within the pores from air with n = 1 to isopropanol n = 1.3), suggesting an application of the nanoporous GaN-based TP structure for optical sensing.

Anisotropy and Controllable Band Structure in Suprawavelength Polaritonic Metasurfaces.

In this Letter, we exploit the extended coherence length of mixed plasmon-exciton states to generate active metasurfaces. For this purpose, periodic stripes of organic dye are deposited on a continuous silver film. Typical metasurface effects, such as effective behavior and geometry sensitivity, are measured for periods exceeding the polaritonic wavelength by more than one order of magnitude. By adjusting the metasurface geometry, anisotropy, modified band structure, and unidimensional polaritons are computationally simulated and experimentally observed in reflectometry as well as in emission.

The effect of sampling techniques used in the multiconfigurational Ehrenfest method.

In this paper, we compare and contrast basis set sampling techniques recently developed for use in the ab initio multiple cloning method, a direct dynamics extension to the multiconfigurational Ehrenfest approach, used recently for the quantum simulation of ultrafast photochemistry. We demonstrate that simultaneous use of basis set cloning and basis function trains can produce results which are converged to the exact quantum result. To demonstrate this, we employ these sampling methods in simulations of quantum dynamics in the spin boson model with a broad range of parameters and compare the results to accurate benchmarks.

Enhancement of spontaneous emission in Tamm plasmon structures.

It was theoretically and experimentally demonstrated that in metal/semiconductor Tamm plasmon structures the probability of spontaneous emission can be increased despite losses in metal, and theoretical analysis of experimental results suggested that the enhancement could be as high as one order of magnitude. Tamm plasmon structure with quantum dots has been fabricated and the emission pattern has been measured. Electromagnetic modes of the structure have been analyzed and modification of spontaneous emission rates has been calculated showing a good agreement with experimentally observed emission pattern.

High quality factor confined Tamm modes.

We demonstrate that quality factors up to 5000 can be obtained in Tamm-like hybrid metal/semiconductor structures. To do this, a Bragg mirror is covered by a thin transparent layer and a metallic film. The reduced losses of these modes are related to an intermediate behavior between conventional Tamm plasmon and Bragg modes lying deeper in the semiconductor medium. One of the most striking features of this approach is that these super Tamm modes can still be spatially confined with the metal. Confinement on micrometric scale is experimentally demonstrated. The simplicity and versatility of high-Q mode control by metal structuration open perspectives for lasing and polaritonic applications.

Confined Tamm plasmon lasers.

We demonstrate that confined Tamm plasmon modes can be advantageously exploited for the realization of new kind of metal/semiconductor lasers. Laser emission is demonstrated for Tamm structures with various diameters of the metallic disks which provide the confinement. A reduction of the threshold with the size is observed. The competition between the acceleration of the spontaneous emission and the increase of the losses leads to an optimal size, which is in good agreement with calculations.

Spatial coherence properties of surface plasmon investigated by Young's slit experiment.

In this Letter, we present an original method to extract the optical properties of surface plasmon polaritons (SPPs) on silver surfaces. A two Young's slit experiment combined with a leakage radiation microscope has been built. By correlating both imagery and coherence measurements on the same area, we are able to address the evolution of the SPP spatial coherence along its propagation. The proposed method could also be useful to explore the properties of complex plasmonic systems.

Coherent emission from a disordered organic semiconductor induced by strong coupling with surface plasmons.

In this Letter, we show that the strong coupling between a disordered set of molecular emitters and surface plasmons leads to the formation of spatially coherent hybrid states extended on macroscopic distances. Young-type interferometric experiments performed on a system of J-aggregated dyes spread on a silver layer evidence the coherent emission from different molecular emitters separated by several microns. The coherence is absent in systems in the weak-coupling regime demonstrating the key role of the hybridization of the molecules with the plasmon.

Evidence for confined tamm plasmon modes under metallic microdisks and application to the control of spontaneous optical emission.

We demonstrate strong confinement of the optical field by depositing a micron sized metallic disk on a planar distributed Bragg reflector. Confined Tamm plasmon modes are evidenced both experimentally and theoretically, with a lateral confinement limited to the disk area and strong coupling to TE polarized fields. Single quantum dots controllably coupled to these modes are shown to experience acceleration of their spontaneous emission when spectrally resonant with the mode. For quantum dots spectrally detuned from the confined Tamm plasmon mode, an inhibition of spontaneous emission by a factor 40±4 is observed, a record value in the optical domain.

Continuous-wave 1.55 microm diode-pumped surface emitting semiconductor laser for broadband multiplex spectroscopy.

A room-temperature-operating vertical external cavity surface emitting laser is applied around 1550 nm to intracavity laser absorption spectroscopy analyzed by time-resolved Fourier-transform interferometry. At an equivalent path length of 15 km, the high-resolution spectrum of the semiconductor disk laser emission covers 17 nm simultaneously. A noise-equivalent absorption coefficient at 1 s averaging equal to 1.5 x 10(-10) cm(-1)Hz(-1/2) per spectral element is reported for 65 km, the longest path length employed.

Management of incidental hyperglycaemia in acute medical emergencies.

AIMS: To assess whether compliance with management guidelines for hyperglycaemia in acute medical emergencies was affected by prior diagnosis of diabetes, and to assess the effect of an educational campaign upon management. METHODS: Prospective study of management of adult patients admitted to an acute medical admissions unit in 2002, with repeat in 2003 after an educational campaign. RESULTS: The management of 251 patients in 2002 and 357 patients in 2003 was examined. In patients with no prior diagnosis of diabetes, unsatisfactory management was observed in 60% compared with only 30% of those with known diabetes (P < 0.02). In 2003 these proportions fell to 46 and 16%, respectively, but remained significantly different (P < 0.02). Overall, 30 of 70 (42.9%) patients with hyperglycaemia were managed strictly according to the guidelines in 2002 compared with 33 out of 59 (55.9%) in 2003 (P = 0.14). Satisfactory management was delivered in 55.7% in 2002 and 78% in 2003 (P < 0.01). CONCLUSIONS: The reluctance of doctors to manage incidental hyperglycaemia in acute medical admissions was especially common when the patient was not known to have diabetes. This was only modestly improved by an educational campaign, even though this group are known to have a greater response in terms of morbidity and mortality. Widespread debate of this issue is required to minimize morbidity and mortality due to hyperglycaemia.

A comparison of 0.2 and 0.5 mg intrathecal morphine for postoperative analgesia after total knee replacement.

The optimal dose of intrathecal morphine for postoperative analgesia after major surgery is a matter of debate, with some uncertainty concerning the therapeutic potential and safety of intrathecal morphine in the dose range 0.3-1.0 mg. This randomised double-blind study compared the efficacy and side-effect profile of 0.2 mg and 0.5 mg intrathecal morphine in 70 patients undergoing knee replacement surgery. The primary endpoint was the number of patients requiring rescue analgesia (tramadol) during the first 24 h postoperatively. Secondary endpoints included consumption of tramadol and the incidence of adverse effects. Fewer patients in the 0.5-mg group required rescue analgesia in the first 24 h than in the 0.2-mg group (16 (48%) vs 28 (85%), respectively; p = 0.003). Median (IQR [range]) tramadol consumption was lower in the 0.5-mg group than in the 0.2-mg group (0 (0-100 [0-350]) mg vs 100 (50-100 [0-350]) mg, respectively; p = 0.02). The incidence of adverse effects was similar in both groups. This study has demonstrated that 0.5 mg intrathecal morphine produces better analgesia than 0.2 mg after knee replacement without any increase in side-effects.

Effects of the menstrual cycle on mood, neurocognitive and neuroendocrine function in healthy premenopausal women.

BACKGROUND: Neurocognitive functioning may be impaired in the luteal phase of the menstrual cycle due to associated changes in hypothalamic-pituitary adrenal (HPA) axis function. This study examines the relationship between changes in neurocognition and HPA axis function in different phases of the menstrual cycle. METHOD: Fifteen female volunteers, free from psychiatric history and hormonal medication were tested twice, during mid-follicular and late-luteal phases in a randomized, crossover design. Mood, neurocognitive function, and basal cortisol and dehydroepiandrosterone (DHEA) were profiled. RESULTS: Relative to the follicular phase, verbal fluency was impaired in the luteal phase and reaction times speeded on a continuous performance task, without affecting overall accuracy. 'Hedonic' scores on the UWIST-MACL scale were decreased in the luteal phase. There was also evidence of changes in the function of the HPA axis, with 24 h urinary cortisol concentrations and salivary DHEA levels being significantly lower during the luteal phase. CONCLUSIONS: These data suggest that luteal phase HPA axis function is lower than in the follicular phase in premenopausal healthy women. This putative biological difference may be important for our understanding of the aetiopathogenesis of menstrually related mood change and neurocognitive disturbance.

Hyperglycemia, lumbar plexopathy and hypokalemic rhabdomyolysis complicating Conn's syndrome.

BACKGROUND: Lumbosacral plexopathy is a complication of diabetes mellitus. Conn's syndrome from an aldosterone secreting adenoma may be associated with hypokalemia and rhabdomyolysis but mild hyperglycemia also usually occurs. METHODS: Case description. RESULTS: A 70-year-old male diagnosed as having Conn's syndrome, hypokalemia and mild hyperglycemia developed rhabdomyolysis and lumbar plexopathy as a presenting feature of his hyperaldosteronism. His rhabdomyolysis rapidly cleared following correction of hypokalemia but recovery from the plexopathy occurred slowly over several months. Definite resection of the aldosterone secreting adenomas reversed the hyperglycemia. CONCLUSIONS: Our patient developed lumbar plexopathy resembling that associated with diabetes mellitus despite the presence of only mild and transient hyperglycemia.

Effect of effort on meal selection and meal acceptability in a student cafeteria.

Past laboratory and field studies show that the effort necessary to obtain food acts as a determinant of food selection and consumption. Two studies examined the impact of increasing the effort needed to obtain candy or potato chips on selection in a normal lunch setting. In the first study, food selection, acceptance and intake were obtained during the first week baseline and under the effort manipulation during the second week. With increased effort, candy selection dropped dramatically in week 2. Subjects substituted items from the desert, fruit and accessory food groups. In the second study, food selection and acceptance were measured during a 2-week baseline, a 3-week effort period, and a 3-week recovery period. With increased effort, potato chip selection dropped dramatically and only partially recovered in the last phase. Subjects substituted items from the starch food group. These results demonstrate that changes in the effort needed to obtain food can have a nutritional impact in an actual eating situation and could be an important part of a healthy eating strategy.

Activation of glutamate receptors and glutamate uptake in identified macroglial cells in rat cerebellar cultures.

1. Patch-clamp methods have been used to examine the action of excitatory amino acids on three types of glial cell in cultures of rat cerebellum, namely type-1-like astrocytes, type-2 astrocytes and oligodendrocytes. In addition we have examined glutamate sensitivity of the precursor cell (the O-2A progenitor) that gives rise to type-2 astrocytes and oligodendrocytes. 2. Glutamate (30 microM), quisqualate (3-100 microM), (S)-alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA, 10-30 microM) and kainate (10-500 microM) were applied to cerebellar type-2 astrocytes examined under whole-cell voltage clamp. Each of these agonists induced inward currents in cells held at negative membrane potentials. The currents reversed direction near 0 mV holding potential. N-Methyl-D-aspartate (NMDA, 30-100 microM) or aspartate (30 microM) in the presence of glycine (1 microM) did not evoke any whole-cell current changes in type-2 astrocytes. 3. The distribution of glutamate receptors in type-2 astrocytes was mapped with single- or double-barrelled ionophoretic pipettes containing quisqualate or kainate. Application of these agonists (current pulses 100 ms, 50-100 nA) to cells held at -60 mV evoked inward currents of 20-120 pA in the cell soma and 10-80 pA in the processes. Responses could also be obtained at the extremities of processes (approximately 60 microns from the soma). 4. Quisqualate or kainate (at 30 microM) applied to O-2A progenitor cells from rat cerebellum or optic nerve induced whole-cell currents (quisqualate 20-30 pA; kainate 20-50 pA, holding potential, Vh = -60 mV) that reversed near 0 mV. In common with type-2 astrocytes, the progenitor cells did not respond to NMDA (30 microM). 5. Type-1-like astrocytes produced large inward currents to glutamate (30 microM). These currents remained inward-going at holding potentials as positive as +80 mV and were not accompanied by any apparent noise increase. This result can be explained by the presence of an electrogenic glutamate uptake carrier. In cells kept up to 4 days in vitro, quisqualate, kainate and NMDA each failed to produce any whole-cell current changes, indicating the absence of receptors in type-1-like astrocytes at this stage in culture. Furthermore the glutamate uptake currents in type-1-like astrocytes were inhibited when external Na+ was replaced by Li+, although Li+ was found to pass through the glutamate channel in type-2 astrocytes.(ABSTRACT TRUNCATED AT 400 WORDS)

Marihuana-derived material: biochemical studies of the ocular responses.

Some biochemical factors of the iris-ciliary body of the rabbit have been examined for effects induced by water-soluble marihuana-derived material (MDM). Adenylate cyclase activity and sensitivity to beta-adrenergic agonists were unchanged, as measured 4 hours after MDM administration in vivo. Magnesium-dependent and anion-sensitive, but not sodium-potassium, ATPase activities were inhibited 6 hours after MDM administration in vivo, although they were unaffected by in vitro incubation. Topical administration of a potent substance P antagonist had no effect on the time course or magnitude of intravenous MDM-induced ocular effects in rabbit. Intravenously administered sugars antagonized the effects of MDM on intraocular pressure. A variety of drugs which display a range of biochemical effects varying from beta-adrenergic receptor agonism, to alteration of glycoprotein residues were employed. None of the agents employed, ranging from cAMP modifiers to protein synthesis blockers, had any effect on the MDM-induced response. It is apparent that the mechanism underlying the ocular hypotensive effect of MDM does not reside in mediation through adenylate cyclase, ATPase or substance P, but rather through a mechanism mediated by terminal sugar moieties on the molecule. The data suggest that modification of the surface membrane glycoprotein residues on the ciliary epithelium can induce marked alterations in aqueous humor flow rate.

Intraocular pressure following systemic administration of cannabinoids.

Various cannabinoids have been tested for activity compared to delta 9-THC in reducing intraocular pressure after intravenous administration in rabbits at 0.1 mg or 1 mg/animal. Comparison of l-delta 9-, delta 8-, 11-OH-delta 9- and 11-OH- delta 8-THC indicates that minor configurational changes have only a small influence on activity with regard to induction of a fall in intraocular pressure, although 11-OH-delta 8-THC has increased activity. 8 alpha-OH-, 8 alpha-diOH- and 8 beta-diOH-delta 9-THC have little or no activity but 8 beta-OH-delta 9-THC is as active as delta 9-THC indicating that the hydroxyl group in the beta-position does not influence activity. Modification of the C5H11 alkyl side chain (3'-OH-delta 9-THC) reduced activity to 20% relative to delta 9-THC. Cannabidiol (CBD), cannabichromene, cannabigerol and olivetol had no activity, but 10-OH-CBD had some activity at 2 mg/animal. Cannabinol (CBN) had about half the activity of delta 9-THC and activity was reduced further with 1'-OH-CBN, indicating that side chain modification reduced activity. Neither delta 9-THC, nor cannabigerol, had any effect on intraocular pressure or total outflow facility in the rhesus monkey, suggesting species differences in ocular responses to cannabinoids. Further studies on modification of these compounds is warranted in order to further delineate the structure-activity relationships.

Water soluble marihuana-derived material: pharmacological actions in rabbit and primate.

Further studies have been made with water soluble marihuana-derived material (MDM). Neither adrenergic, cholinergic, aldosterone, dopamine or serotonin antagonism affected the fall in intraocular pressure induced by MDM. Partial blockade was obtained with galactose, glucose, or mannose, but not arabinose, when the latter were given at intravenous concentrations of 1 gm/animal and MDM was given at 25 micrograms animal, suggesting that these sugars may be involved at the active site of the MDM glycoproteins. Dexamethasone was without effect on either intravenous or intravitreal MDM indicating that the MDM effect is not a non-specific response to a protein. A similar plant glycoprotein, larch arabinogalactan, at 200 micrograms/animal was without effect on intraocular pressure. Aqueous humor flow rate was increased 3 hours after MDM administration, a period corresponding to the intraocular pressure increase caused by MDM, and fell to 20% of control values when the fall in intraocular pressure occurred. Blood flow through the iris was increased at both one and six hours after intravenous MDM injection indicating a vasodilation which could contribute to the initial increase in intraocular pressure. Intravitreal injection of MDM in rabbit and rhesus monkey caused a fall in intraocular pressure only after a 24 hour delay: the unilateral response indicated that systemic metabolism was not required for activity and the delay was likely caused by the diffusion time to the ciliary processes from the mid-vitreal injection site. The changes in beta-receptors, adenylate cyclase and carbonic anhydrase in the ciliary processes are minimal indicating a possible vascular mechanism of action of MDM.